PHTY206 Lecture 24: Introduction to orthopaedic inpatients
Introduction to orthopaedic inpatients
• Orthopaedic physiotherapy
o Related to the preparation for, or rehabilitation from orthopaedic surgery or related
to an orthopaedic hospital admission
o Primarily but not exclusively related to the multidisciplinary impatient management
of elective or trauma related orthopaedic admissions
• Why have orthopaedic surgery
o Degenerative disease (OA)
o Trauma (fractures, dislocations)
o Reconstruction (knee, shoulder)
o Pathological processes (Ca, RA)
o Prophylaxis/function (spinal scoliosis)
o Pain
• The Orthopaedic team
o Patient, family, carers
o Doctors (consultant, registrar, resident)
o Pain team (anaesthetist)
o Nursing (pre-admission, theatre, ward)
o Support staff (ward receptionist, transport, food services, cleaners)
o Community liaison (CHIP nurse)
o Allied health
• Physiotherapist, assistants and students
• OT
• Social worker
• Pharmacist
• Community referral organisations (mobile rehab, DART, Blue Care, etc)
• Assessment of the orthopaedic inpatient
o Preparation
• Interpretation and planning
• Medical chard/clinical pathway
▪ Obtain relevant information
▪ HPC
• Operation report, post op orders, protocols
• Demographic info
• Investigations
• Hb, imaging, blood tests etc
▪ PMHx
• Respiratory Hx, cardiac Hx, OP, etc.
▪ PSHx
• Previous orthopaedic surgery, other major surgery
▪ Social Hx
• Homesupport, home access
▪ Functional Hx
• Previous level of function (aids, distance, assistance required)
• Bed chart
▪ Medications (what, when, route), obs (HR, BP, temp, RR, SaO2)
o Subjective examination
• Assessment, interpretation and planning
• Confirm what you know from the chart and attempt to fill the gaps
• Maintain rapport but keep control of the situation
Document Summary
Social worker: assessment of the orthopaedic inpatient, preparation. Interpretation and planning: medical chard/clinical pathway, obtain relevant information, hpc, operation report, post op orders, protocols, demographic info. Investigations: hb, imaging, blood tests etc, pmhx, respiratory hx, cardiac hx, op, etc, pshx, previous orthopaedic surgery, other major surgery. Productive: observe rr - work of breathing, normal bi-basal expansion, auscultation - normal breathing sounds, when necessary, a full respiratory assessment should be performed, circulatory. For patients at risk of dvt: commonly seen in calf and assessed by looking for. Swelling in calf: redness of calf, positive homan"s sign (calf pain on passive ankle df) Increased temperature on palpation: neurological, modified neurological assessment is required in the presence of spinal or epidural anaesthetic, will help assess patient"s ability to mobilised and should include, hip, knee, ankle strength and sensation. Sit stand: mobility, assistance, therapist manual/hands on assistance, 1 x assist, 2 x assist. Supervision: requires verbal cues, no manual/hands on assistance required.
